Background: Colorectal cancer (CRC) incidence is rising in adults < 50 years, now accounting for nearly one-tenth of new U.S. cases. In response, the U.S. Preventive Services Task Force lowered the recommended screening age from 50 to 45 years in 2021. To learn whether screening behavior has kept pace, and where inequities may remain, we interrogated recent national survey data.
Methods: Behavioral Risk Factor Surveillance System files for 2008–2022 (~1.3 million respondents) were pooled. Adults aged 45 to 79 years who answered colonoscopy/sigmoidoscopy items (HADSIGM3/4 or SIGMSCPY + COLNSCPY) formed the analytic set. A custom R function (scrVSage) computed crude screening prevalence within eight 5-year age bands for each race/ethnicity, sex, income, and insurance stratum. Year-specific proportions and absolute gaps were visualized to track change over time.
Results: Overall screening prevalence climbed from 58% in 2008 to 69% in 2022, an 11-percentage point (p.p.) increase. The Black-White gap narrowed from +6.4 p.p. to −0.8 p.p., indicating practical parity. Disparities remained sizable for Hispanics (−9.1 p.p.) and Asians (−11.3 p.p.) in 2022. Across all years, being insured or having household income ≥$75,000 conferred ~20 p.p. higher screening than being uninsured or earning <$25,000, with no evident narrowing. Recency analysis showed Black respondents slightly less likely than White respondents to be ≥10 years overdue (5.9% vs. 10.1%). Sex differences were small (<2 p.p.). Uptake increased in every five-year age band, including the newly eligible 45 to 49 group.
Conclusions: U.S. CRC screening has improved steadily since 2008, and the historic Black-White disparity has effectively closed. Hispanic, Asian, low-income, and uninsured continue to have lower screening prevalence.
